What Medical Doctors Need to Know about Chinese Herbal Medicine (TCHM) for COVID 19

Part I

My brother is a trauma surgeon in Detroit, I was texting with him when the governor declared a state of emergency.  He is called into the ER for surgery when needed – which is often.  I’m afraid for him.  But I’m less afraid because he said, hey, give me some herbs.  I might need help. 

The Nobel Prize in 2015 was given to Professor Youyou Tu for applying Traditional Chinese Medical knowledge to the treatment of malaria, and the World Health Organization (WHO) successfully applied it in combination with chloroqine – and lowered the infection rate from 2.5% to .03%.

Thousands of years before this (some scholars date it back to 200BC) the Chinese invented inoculation – vaccines.  It was not invented in the West, it was simply formalized.   I relay these facts to highlight the wisdom to be found in Chinese Medicine, a medical paradigm that has been documented consistently and expanded for thousands of years. Given the current health crisis in the world I am compelled to explain how and why Traditional Chinese herbs work, and how they can be very usefully, as the esteemed publication Nature suggests, applied to help patients with COVID 19.  The refrain that “there is nothing” to help just isn’t true.

Luckily most cases of Covid 19 are mild – as we know now about 80% of us will have little or no symptoms.  But for the 20% who do become dangerously ill, anything that improves the situation, even just raising oxygen saturation by a point or two could save a life.

My mother, who is 77, seems to have the virus, though the tests where she lives just became available so we will wait to see.  But her symptoms were strong, and she started losing the ability to breathe deeply.   She complained of a powerful headache, sore throat, cough, fatigue and shortness of breath.  She made a test for herself using a song she likes to dance to – though usually able to dance all the way through she couldn’t anymore, her oxygen saturation was down to 92%.

I first applied two basic principles in my use of Chinese herbs – open the lungs and clear heat. In addition I had her test her Nitric oxide (which is recommended by Medscape in its list of COVID 19 treatment strategies), which was very low, and had her raise this with beet juice. Shortly after taking the formula she reported marked improvement in her ability to draw breath, and her oxygen saturation has now improved 6 points to a healthy 98%.

Second I applied some strong anti-virals – including artemisinin, the Chinese herbal extract used by the WHO on malaria (on the very vague theory that if chloroquine works by raising the pH in the endosome to interfere with replication of CoV 2 then artemisinin might work also??).  These herbs are powerful enough to significantly lower the malaria rate, and powerful enough to help ease viral infections (as well as bacterial) in all other types of infection.

Thirdly I had her create a hot infusion of known anti-viral herbal oil in a bowl and inhale the steam.  Tea tree oil, for example, is a strong anti-viral – and applying this directly to the source of infection seemed like a good idea.

Nature reports on a Chinese herbal combination for influenza with strong binding with neuraminidase, providing comparable protection to zanamivir.  Zanamivir can also be inhaled, with a 4.5-day reduction (47.4%) in the median time to alleviation of all significant flu symptoms.  I suggest there may be benefit to inhaled anti-virals in the case of COVID 19.

 

Here’s some science:

This article tested both existing drugs and herbs for guidance for potential drug discovery, finding out which substances might most successfully interfere with viral binding for SARS-CoV 2.  13 of these are Chinese herbs.

Against influenza virus a Chinese medical combination called Xiao Qing Long Tang was well researched and found to enhance interferon (IFN) response through activating p38, JNK/SAPK MAPK pathway, NF-κB and AP-1 nuclear transcription factors.

In Chinese medicine Xiao Qing Long Tang is used for fighting viral infections in the early stages of infection, with cough, sputum and body aches.   It also is used in Chinese hospitals against SARS-CoV 2.

The review board for this research are all academic researchers at well-respected universities including Vanderbilt, the University of Maryland Medical Center, and Harvard Medical School.

Xiao Qing Long Tang is just one of the formulas in the documents translated and provided by the World Health Organization from the hospitals in Wuhan.  The knowledge gained from the previous SARS infection in 2003 enabled a more effective response this time.

This peer-reviewed paper reviews the application of TCM to SARS as a jumping off point for treating COVID 19.  It lists the successful combinations applied then, but more importantly for our purposes lists the most effective isolated constituents (like artemisinin) from Chinese herbs, including mode of action with reference research papers:

Though the goal here is to get you to understand that Chinese herbal medicine actually can contribute to the treatment of COVID 19, I’ll point to this as supporting evidence – the FDA is currently reviewing the clinical trial research for what will be the first TCM “drug” approved.

The Journal of American College of Cardiology (ACC)  published a brief on the FDA-regulated phase III clinical trial for a Chinese herbal drug called T89, a 2-herb combination that, according the the ACC: demonstrated excellent therapeutic benefit for A [stable angina] patients. Drug synergistically works on microcirculation, energy metabolism and blood viscosity – offers an new treatment option for patients with A [stable angina].

Part II

It is no longer 200 BC (when the first text for Chinese Medicine/TCM was compiled).  Current TCM includes detailed laboratory experimentation and research, and the FDA of China (the SFDA) has a list of approved anti-virals, based on proven efficacy.

In addition to classical bioscreening, computer-aided molecular design and docking-based virtual screening technologies are also being applied to the antiviral screening of Traditional Chinese Herbal Medicine (TCHM).

This paper provides the lab approaches used to determine the anti-viral properties of the herbs, and as in the case with COV 2 we are looking for protease inhibitors, viral polymerase inhibitors, and integrase inhibitors, among others.   Such inhibitors are classified as direct antiviral agents. Previous studies have provided evidence of the direct antiviral activity of many medicinal herbs.

Viral entry inhibitors are ideally the goal, as these, like chloroqine, would stop the virus from gaining entry.  (Chloroquine works because the replication is mediated by a pH-dependent mechanism, and chloroquine changes the pH of the endosome.)

Replication inhibitors would be second most desirable, and I would use them in combination with viral entry inhibitors and immune modulators.  Inhibitors of viral proteases, polymerases, integrases (helicases), and reverse transcriptases of HIV, HCV, and HSVs have been clinically successful.  Compared with anti-entry TCHMs, compounds targeting replication are more chemically diverse and more virus-specific.

Inhibitors of packaging and assembly, the final step in the viral infection cycle, are another point of approach. No antiviral agents that target this stage have been developed, partially due to limited knowledge of the packaging and assembly mechanisms of most viruses.  Studies of some TCHMs have revealed that their mechanisms of action involve viral packaging and assembly, but the number remains limited, and the level of understanding is still preliminary.

Immunomodulators are another piece of a complete strategy for combating viruses/COVID 19.  These are especially important given the presentation in the most severe cases of COVID 19.  ARDS/pneumonia leads to death in part due to the excessive host immune response leading to systemic tissue/organ damage.  Immunomodulators both up regulate cytokines and balance the cytokine response, providing both anti-viral activity and a net anti-inflammatory response. These are well-documented in TCHM.

Polysaccharides are potent interferon inducers and good viral entry inhibitors. Glycyrrhizin has activity against entry, replication and immunomodulation.

You can find a brief rundown of the best immunomodulators here.

Inaflammosome – this response can be antagonized by a number of additional natural products found in the Opus23 database of natural products:  astragalus, huperzine A, curcumin, melatonin.

 

Part III

The WHO has translated and made available to the community a meta-report on the clinical picture of COVID 19 from a hospitalist perspective from China.  This report includes relevant clinical manifestations/symptomatology, epidemiological characteristics, detailed pathological changes, and treatments.  These include a detailed and specific roster of TCM herbal formulas targeting various presentations and stages of infection.

I have used all of this information, plus my experience as a Doctor of Chinese Medicine (7 years of school and two licensing exams), to create herbal formulas specific to the various stages of COVID 19 given my experience of the symptoms.  With my hand on my heart and from a hippocratic perspective I tell you:  Chinese Herbal Medicine, when appropriately applied by experts, will help you to save a life – maybe even yours.

 

For more information or expert guidance on the use of Chinese Herbal Medicine for COVID 19 please contact me, laura@drlaurakelly.com.